Provider Demographics
NPI:1528318490
Name:CHODAN, JENNIFER LYNN (MS SPECIAL EDUCATION)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:CHODAN
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GABRIELS PATH
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5146
Mailing Address - Country:US
Mailing Address - Phone:845-724-3578
Mailing Address - Fax:
Practice Address - Street 1:117 GABRIELS PATH
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5146
Practice Address - Country:US
Practice Address - Phone:845-724-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY411910086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist